The association between fluid balance and outcomes after subarachnoid hemorrhage
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We sought to determine the association between early fluid balance and neurological/vital outcome of patients with subarachnoid hemorrhage.
Hospital admission, imaging, ICU and outcome data were retrospectively collected from the medical records of adult patients with aneurysmal SAH admitted to a level-1 trauma and stroke referral center during a 5-year period. Two groups were identified based on cumulative fluid balance by ICU day 3: (i) patients with a positive fluid balance (n = 221) and (ii) patients with even or negative fluid balance (n = 135). Multivariable logistic regression was used to adjust for age, Hunt-Hess and Fisher scores, mechanical ventilation and troponin elevation (>0.40 ng/ml) at ICU admission. The primary outcome was a composite of hospital mortality or new stroke.
Patients with positive fluid balance had worse admission GCS and Hunt-Hess score, and by ICU day 3 had cumulatively received more IV fluids, but had less urine output when compared with the negative fluid balance group. There was no difference in the odds of hospital death or new stroke (adjusted OR: 1.47, 95%CI: 0.85, 2.54) between patients with positive and negative fluid balance. However, positive fluid balance was associated with increased odds of TCD vasospasm (adjusted OR 2.25, 95%CI: 1.37, 3.71) and prolonged hospital length of stay.
Although handling of IV fluid administration was not an independent predictor of mortality or new stroke, patients with early positive fluid balance had worse clinical presentation and had greater resource use during the hospital course.
KeywordsCerebral aneurysm Delayed ischemic neurologic deficit Human Subarachnoid hemorrhage Cerebral vasospasm Triple-H therapy Hypervolemia Hypertension Hemodilution
This study was performed at Harborview Medical Center, University of Washington, Seattle WA. This project was supported in part by the Washington State Society of Anesthesiologists and by departmental funds.